Laparoscopic surgery is carried out by passing trocars through multiple small incisions, or by using Single Port Laparoscopic Surgery (SPLS) which utilizes only a single incision and single port. The benefits of laparoscopic surgery and/or SPLS have been reported to include reduced post-operative pain, tissue trauma and scarring as well as faster recovery from surgical procedures.
The accumulation of blood and other fluid during surgery interferes with many procedures, such as cholecystectomies. Accordingly, suction is used during laparoscopic surgery for the evacuation of blood, bile, pus, irrigation fluid and/or vapours and the irrigation of tissue using saline solutions and the like is used to assist in this process. Sucker-irrigator apparatus are usually handheld devices using one actuator for suction and another actuator for irrigation (typically controlled by a trumpet valve mechanism), and which comprise a long rigid tube for insertion into the patient's abdomen through the laparoscopic port. Typically two flexible hoses extend from the handpiece controller: one hose is connected to a suction canister, which in turn is connected to wall suction, and the other hose is attached to a source of pressurised irrigation fluid. The handpiece controller determines whether irrigation or suction is applied through the long rigid tube entering the abdomen. The rigid tube of sucker-irrigators is commonly designed to fit in a 5 mm laparoscopic trocar, although wider sucker-irrigator tubes having a diameter of 10 mm are used with larger laparoscopic trocars when evacuating thicker material such as clots and particulate matter, and 3 mm sucker-irrigators are available, but less frequently used. When a sucker-irrigator is required, a surgeon will typically withdraw at least one of the laparoscopic instruments being used from its laparoscopic trocar and insert the sucker-irrigator into the laparoscopic trocar. This procedure may take some time, during which period bleeding may continue, further obscuring the surgeon's view. On occasion, an additional trocar may be inserted to house a sucker-irrigator so that suction-irrigation may be carried out at the same time as haemostasis. Conventional sucker-irrigators typically use screw-in or click in rigid tubing to attach to the handpiece controller.
Furthermore, in accessing target tissue to be operated upon, medical personnel typically use a retractor system or apparatus to hold adjacent tissue to be retracted from the operating field. This is particularly the case where the laparoscopic procedure is carried out in the abdomen of a patient and obstructive tissue needs to be temporarily and gently moved out of the way. Conventional retractor systems apply a positive force to the under-surface of the organ to be retracted. Alternatively, vacuum retraction apparatus are available which are internally located within the patient and which are connected to suction apparatus via a length of tubing passing through an incision in the abdominal wall, as shown in FIG. 1A. However, such tubing is prone to compression, angulation or bending as it passes through the incision, by the tissues themselves or the adjacent laparoscopic trocar. This interrupts the suction provided and thus the efficiency of tissue retraction. This particularly happens where skin incisions are too small and the trocar and tubing are tightly fitted within the incision. Suction interruptions during surgical procedures are inconvenient and time-consuming, and can interfere with the surgical procedure. Where the tubing passes through a channel within a single port laparoscopic surgery device such as the SILS™ Port, it will be subject to even higher compressive forces as the adjacent laparoscopic instruments are angulated. As such, the tubing requires protection from compression by drawing it through a laparoscopic trocar within the SILS™ Port (FIG. 1B). Such an arrangement, however, is bulky and requires additional steps which increase the time required.
Laparoscopic procedures also involve insufflation wherein inert, non-toxic gases, such as carbon dioxide, are insufflated into a body cavity to provide internal room (pneumoperitoneum) for surgical manipulation and viewing by elevating the abdominal wall. The incisions used in laparoscopic surgery, while small, may permit leakage of the insufflation gas from the body cavity (under positive pressure) from around the trocars inserted, particularly where the tubing of vacuum retractor systems or apparatus is passed adjacent to the trocar. This insufflation gas leakage may reduce the dimensions of the pneumoperitoneum, making it necessary to insufflate further gas into the body cavity which wastes the gas (CO2) and may interfere with the surgical procedure. It is a technical challenge to cut an incision in a patient's abdominal wall that is large enough to accommodate the laparoscopic trocar and retractor system tubing without constricting the tubing, yet is small enough to minimise gaps and reduce leakage of insufflation gas.
It is desirable to provide a device and/or method that will alleviate one or more of the shortcomings of suction and/or irrigator systems and apparatus and their use.